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General NPI Number Information
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NPI Number | 1861731259
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Entity Type | Organization
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Legal Business Name | KIBOU COUNSELING SERVICES INTERNATIONAL LLC
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Dates
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Enumeration Date | 02/06/2013
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Last Update Date | 02/06/2013
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Provider Practice Location Address
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Address Line | 201 S SKINKER BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63105-2317
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Country | US
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Telephone | 314-520-8167
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Fax |
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Provider Business Mailing Address
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Address Line | 4921 MURDOCH AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63109-2944
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Country | US
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Telephone | 314-520-8167
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER/THERAPIST
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Name | AMYRUTH GREGORY BARTLETT
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Credential | LLC
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Telephone | 314-520-8167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2008031874
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License Number State | MO
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